Practical approach to deal with prolonged fever
Fever is body's defense against intruders. In maximum cases, it usually lasts for three to five days. However, the causes of fever in certain cases are hard to pin down and the duration may be prolonged enough to cause unbearable suffering. Knowing the general approach to identify the cause may help your doctor to reach early diagnosis and can lessen the intractable infliction. Fever, when persists beyond 14 days, is termed as prolonged fever or Fever of Unknown Origin (FUO). It is distinguishable from the common viral fever which is self-resolving that may lasts a week or longer, but generally not as long as two weeks. We should keep in mind that many different diseases may present as prolonged fever. They include: • Infections - urinary tract, upper respiratory tract, bone and joint, central nervous system, heart. • Autoimmune diseases - juvenile rheumatoid arthritis, systemic lupus erythematosis (SLE), polyarteritis nodosum, inflammatory bowel disease. • Cancers like leukemia, lymphoma • Miscellaneous - factitious fever, drug fever, etc. A certain percentage of cases self-resolve over a period of weeks to months without ever coming to a specific diagnosis. When approaching a patient with prolonged fever, it is helpful to remember that the patient more often has an occult presentation of a common disease than a truly rare disease. Recoding the temperature pattern and explaining the proper history to doctor will help to attain a diagnosis at the beginning. And the appropriate treatment can be delivered rapidly to help recover soon. The most important information to attain an early diagnosis is generally revealed by the history and physical examination. According to experts, history has utmost importance in diagnosis any kind of disease. Significant clues may be identified only after elaborated history is taken. Important elements of the history include: fever pattern, weight loss, and other constitutional symptoms, such as anorexia and night sweats. Here are examples of how history reveals the disease. If fever is associated with chill and rigor and recurs once in every 48 hours with a history of travelling malaria endemic zone, it is possibly due to malaria. If the fever is associated with weight loss then it goes under favour of tuberculosis, malignancy or cancer. Like these, exposures with ill contacts, residence and travel, animals, insects, unpasteurised dairy products, wild game, medications, tuberculosis contacts, HIV risk factors are need to be explored. Symptoms/signs also may help discriminate among possible diagnoses, e.g., rash, joint findings, cardiac/respiratory or other localising abnormalities. Prolonged fever also may be associated with many noninfectious illnesses, such as juvenile rheumatoid arthritis. Therefore, when an obvious illness is not present, it is important to rule out latter phase the underlying causes with CT scans, blood studies and extensive antibody testing for other less common infectious illnesses. The treatment of prolonged fever is supportive until the specific diagnosis is made. Physicians recommended only Paracetamol to lower the temperature. Experts strongly forbid giving any empirical therapy. Antibiotics or corticosteroids should generally not be administered unless a specific diagnosis justifying their use is uncovered. In the absence of a diagnosis, such empiric treatment may provide transient response and frequently masks the diagnosis, resulting in a more prolonged and complicated disease. Maintaining fluid and electrolyte balance with adequate fluid and juice is important during the prolonged phase. Hospitalisation can be considered if the clinical and laboratory pictures are worrisome like sever vomiting, diarrhoea, rash, breathing difficulty, extremely high temperature and when the physician recommends to explore proper fever history or to reach a early diagnosis in coordination of consultations and diagnostic tests. Children are especially in need of urgent care. It is strongly recommended to consult a physician before getting any treatment for children with any fever and adult with prolonged fever.
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